Provider Demographics
NPI:1902120637
Name:WOMACK, CELIA C (DPH)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:C
Last Name:WOMACK
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SMITHVILLE HWY
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1669
Mailing Address - Country:US
Mailing Address - Phone:931-474-9322
Mailing Address - Fax:931-474-9324
Practice Address - Street 1:835 SMITHVILLE HWY
Practice Address - Street 2:SUITE 25
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1669
Practice Address - Country:US
Practice Address - Phone:931-474-9322
Practice Address - Fax:931-474-9324
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist